Kitchener Sports Association
www.kitchenersports.ca
(The Applicant MUST be a resident of Kitchener, Waterloo or the Townships of Wilmot, Wellesley or Woolwich)
Scholarship Application Form – To Be Completed and Signed by the Applicant
Deadline for Submission – 12 noon on Friday, April 3, 2015
Name of Applicant:
Home Address:
City/Township:
Postal Code:
Phone:
Email:
Birth Date:
Secondary School Attended:
Did you complete your secondary education in 4-years or 5-years?
List any involvement in the school community other than sports (i.e., student council, committees, clubs, drama, tutoring):
List any community involvement or volunteering that you did outside of school:
List any employment that you held or currently have:
List the post-secondary institution (i.e., University or College) that you have been accepted to and will attend:
OR
List the post-secondary institution(s) (i.e., University or College) that you have applied to and are awaiting acceptance:
Attestation of Applicant: “I affirm that, to the best of my knowledge, all the information supplied with this application is accurate,
and that my intention is to further my education with registration at a recognized post-secondary institution in the immediate
autumn term. I acknowledge that a late or incomplete or inaccurate application will be rejected. ”
Signature of Applicant:
Date:
NOTE: A complete application package includes this cover page 1 that is signed and dated, plus a response to each of the
sub-sections (A), (B), (C) and the mandatory attachments (D), (E) as described below on page 2. You must submit the
original package plus five (5) copies for a total of six (6) application packages to be considered.
Application Form
Page 1
Kitchener Sports Association
www.kitchenersports.ca
Additional Requirements to Scholarship Application Form
Additional Requirements: Please prepare responses to each of the following five (5) sub-sections in a computer –
generated submission. Your response to each sub section (A), (B) and (C) should be within the required range of 150 to
250 words. Scoring of the application will be based in part, on satisfying the word length requirement for the following
categories:
(A) Future:
• Your plans for post-secondary education, including faculty of study and degree/diploma accepted to or pending
• Your career ambitions following university/college
(B) Minor Sports Commitment:
• Your past, present and proposed involvement in organized sport(s), whether school based or community
organization.
(C) Demonstration of Need for Financial Assistance:
• Initiatives that you have taken to finance the cost of your post secondary education and list all other
scholarships/incentives/financial assistance applied for, pending and/or received, including amounts.
• Indicate if and how your parent(s)/guardian(s), as appropriate, are financially supporting your education costs.
• Indicate if your parent(s)/guardian(s), as appropriate, are currently financially supporting the education costs of
other siblings in the household
• Make evident your need for financial assistance including anticipated tuition & student fees, books and lodging
costs per year of study and total for the program.
Attachments: All attachments must be included with your application package in order to be considered.
(D) Two “Letters of Reference” – one from each of
• A teacher from your secondary school, and
• An official (coach, etc) from a minor sport in “(B)” above
(E) The current (i.e., most recent) official transcript of Student Academic Record.
Application Form
Page 2
Kitchener Sports Association
www.kitchenersports.ca
GENERAL GUIDANCE AND INFORMATION FOR SCHOLARSHIP APPLICANT
Application Deadline: 12 noon on Friday, April 3, 2015
Note the application deadline cannot be extended
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Checklist for Submission- Ensure that you have:
Signed and dated the application page 1
Provided a written response of 150 to 250 words for each category (A), (B) and (C)
Included two letters of reference and your official transcript
Do Not include any other documents in your application
Provide the original plus 5 copies for a total of six (6) packages.
Mail or Deliver Applications to:
Kitchener Sports Association Scholarship Program
c/o MTE Consultants Inc., 520 Bingemans Centre Drive, Kitchener, ON N2B 3X9
Attention: Co-Chair
Scholarship Recipients:
Up to six (6) recipients will be chosen to receive a $2,000 scholarship award from KSA. Those recipients chosen to
receive a scholarship award will be notified by telephone before the awards dinner. The recipient and two of his/her
guests will be invited to attend the Scholarship Awards Dinner at the Eidelweiss Tavern, with dinner cost covered by KSA.
Each of the recipients will receive a lump sum cheque for $2,000 in their name, from KSA, in September following
satisfactory proof of enrollment at a recognized post-secondary institution in the immediate autumn term.
Scholarship Awards Dinner and Guest Speaker
Tues. April 21, 2015 at 6:30 pm (tentative booking)
Edelweiss Tavern, Doon Village Road, Kitchener
Privacy Statement
The information collected by KSA in this application will be used only for the scholarship award program. The
information will be kept confidential and will not be distributed for another purpose. KSA does not retain the
applications beyond the selection process and awards dinner. KSA does not return applications to the applicant. All such
applications are properly destroyed.
Disclaimer
Services provided by MTE Consultants to the KSA are donated as community service. MTE is not a member, agent or
partner of the KSA.
Enquiries or Additional Information?
Please call and leave a message, including your name and number at 519-208-5126 or email to [email protected]
Application Form
Page 3